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DSH100022U JACKSON HEALTH SYSTEM (Active)
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Main Details
Name
JACKSON HEALTH SYSTEM
Subdivision Name
JBHH ED EMERGENCY SERVICES
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100022U
Medicare Provider Number
100022
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/14/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/6/2015
Last Recertification Date
8/29/2024
Contacts
Authorizing Official
Jackson Health System
Carlos A. Migoya, CEO
(305) 585-6754
Primary Contact
Jackson Health System
VENESSA GOODNOW, AVP & CHIEF PHARMACY OFFICER
(305) 585-7411
Addresses
Street Address
1695 NW 9TH AVE
MIAMI, FL 33136
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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